Additional In Vivo Diagnostic Procedures

Nasal challenge/provocation testing has been proposed as a tool in the diagnosis of allergic rhinitis. It is used in studies of allergic rhinitis, but its utility in clinical practice has not been established. Evidence available regarding the value of this testing is primarily in the form of expert opinion rather than studies assessing the technique. A review of the current published, peer-reviewed scientific literature indicates that the role of nasal challenge testing in the diagnosis and management of allergic diseases has not been established.

Conjunctival challenge testing also has been used in the diagnosis of allergic rhinitis as well as of allergic conjunctivitis. Few data are available regarding the value of conjunctival challenge. The role of conjunctival challenge testing in the diagnosis and management of allergic diseases has not been established, based on a review of the published, peer-reviewed scientific literature.

Provocation-neutralization, sometimes referred to as the Rinkel test, is a procedure that evolved from serial endpoint titration. This method has been proposed as a test for allergies to foods, inhalants and environmental chemicals; it exposes the patient to test doses of substances intradermally, subcutaneously or sublingually, with the goal of either producing or preventing symptoms. There are no standardized protocols, and its safety and efficacy have not been established. Both the American College of Physicians and the American Academy of Allergy and Immunology consider this testing method unproven. Provocation-neutralization is a method often used by physicians who subscribe to the concept of multiple food and chemical sensitivities, also referred to as idiopathic environmental intolerances (IEIs). Based on a review of the current published, peer-reviewed scientific literature, provocation-neutralization is an unproven testing method.

Electrodermal testing, also referred to as "electro-acupuncture," has been proposed as a method to identify substances, especially foods, to which the patient is allergic and to provide information about optimal dilution of treatment extracts in immunotherapy. It is performed with a device that uses a galvanometer to measure electrical activity of the skin at designated acupuncture points. There is no scientific or clinical evidence available that demonstrates that electrodermal testing can diagnose allergies. This technique is considered unproven.

Applied kinesiology involves testing for specific allergies by measuring the patient’s muscle strength. Allergens are placed in containers that the patient holds in one hand while a technician estimates muscle strength in the opposite arm. Based on a review of the published, peer-reviewed scientific literature, this technique is unproven.

Reaginic pulse testing involves measuring a change in pulse rate after the ingestion, injection or sublingual application of an allergen. There is no basis for its role in the diagnosis of allergic disease. A review of the literature indicates that this is an unproven test for the diagnosis of allergies.